Provider Demographics
NPI:1851578074
Name:CHAMPION FIT WELLNESS
Entity Type:Organization
Organization Name:CHAMPION FIT WELLNESS
Other - Org Name:CHAMPION FIT WELLNESS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:DOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-467-7600
Mailing Address - Street 1:10661 HADDINGTON DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-3287
Mailing Address - Country:US
Mailing Address - Phone:713-467-7600
Mailing Address - Fax:713-467-7604
Practice Address - Street 1:3617 SALEM RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-4552
Practice Address - Country:US
Practice Address - Phone:678-212-0496
Practice Address - Fax:678-212-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)